A pediatrics clinic at Fort Leavenworth is providing early intervention for children with developmental issues

Mary Carlton had just taken her 3-year-old son, Sawyer, to the Fort Leavenworth pediatrics diagnostic clinic operated by the University of Kansas Medical Center. She needed to share Sawyer's diagnosis with her husband, Lt. Col. Charlie Carlton, but he was more than 6,500 miles away, on a tour of duty in Iraq.

"I had to tell him on Skype that his son had autism," Mary said.

The diagnostic clinic at Fort Leavenworth began in 2009 to address a problem very unique to military families like the Carltons. Most families at Fort Leavenworth are on post to attend the Army Command and General Staff College, which only lasts 11 months. For a family with a child who needs evaluated, "that's a very short time," says Jennifer Burford, MS, the exceptional family member program (EFMP) manager at Fort Leavenworth.

When Charles was deployed in 2009, Mary was left to marshal their troop of five children at their Fort Leavenworth home. But 3-year-old Sawyer wasn't the child Mary was most worried about.

Josephine, the couple's second oldest, took Charles' deployment pretty hard.

"Josie had a really tough time when Charlie deployed," Mary says of their then 9-year-old daughter. "She completely fell apart and I was really struggling to help her."

Burford suggested Mary bring both kids to the pediatrics diagnostic clinic, which visits the post several times a year to provide diagnoses and treatment plans for military children.

"Josie was my big fire at the time. Sawyer was my little fire, but he was contained," Mary said.

Early intervention is important for treating children with developmental challenges, particularly children with autism, explains KU Medical Center pediatrician Chet Johnson, M.D. "Especially in the first five years of life, there's tremendous changes going on in the brain and you can influence that development based on the experiences a child is provided. If you can offer the right kind of intervention early, you can help children better reach their potential."

But without a timely appointment, there is no early intervention.

"At the time the Carltons participated in the outreach clinic, the wait to get a consultation at KU Medical Center or Children's Mercy Hospital was six to nine months. That was way too long-by the time our families got in, it would be time for them to leave," explained Burford. "Then they would have to reinvent the wheel at their next installation and the one after that."

"I felt relief"

At the same time Mary was struggling with Josie, she was worried Sawyer might be discharged from his special needs school. Sawyer had previously been diagnosed with developmental delay while the family was stationed in Washington, D.C., but he was performing so well that the school on post was trying to transition him from the special needs school.

"The clinic was literally across the street, a one-stop-shop, so I brought them both. I can't imagine having [to schedule the appointments] on my own and drive up to Kansas City with both of them," she said.

With the appointments at the same time, a psychologist evaluated Josie, and Mary was asked to sit in with Sawyer while he was evaluated by a team of KU Medical Center providers including Dr. Johnson.

"At the time, Sawyer carried with him this frog, rubber duck, a mobile play figure, and a stuffed dog. Dr. Johnson asked him the name of the dog," recalled Mary.

"Peanut," Sawyer said, which Mary added was the name of their family dog.

The name of his frog? "Frog."

And the duck? "Duck."

And the person figure? "Person."

"When Sawyer said person, I thought Dr. Johnson was going to fall out of his chair," Mary said. "It was very obvious that Sawyer was very rigid. He had no imaginary play."

Josie was diagnosed with anxiety and depression and Sawyer with autism. The clinic staff asked if Mary would like to speak with a nurse about the diagnoses.

"My first thought was, 'Why? I have three other kids to pick up.' I hadn't processed it," Mary recalled. "It was hard, but I was so thankful that they told me they each had something serious going on. I felt relief. I'm not crazy, I am seeing something real."

Mary met with the nurse to discuss the diagnoses and treatment plans.

More than a decade of diagnostic clinics

Although the clinic at Fort Leavenworth was established three years ago, the Center for Child Health and Development at the University of Kansas Medical Center has been hosting pediatric diagnostic outreach clinics across the state for more than a decade.

The clinics are free, with costs covered by a grant from the Kansas Department of Health and Environment and private donations from organizations like the Scottish Rite, which provides funding for the on-post clinics.

Each diagnostic clinic, whether at Fort Leavenworth, Hays, Dodge City, Holton, or one of the many other locations in Kansas, has two teams of providers that evaluate children for mental and physical issues.

"The makeup of each team changes based on the needs of the kids we're seeing," said Vicki Miller, M.S.W., who coordinates KU's Children and Youth with Special Health Care Needs Program, which includes many of the outreach clinics. Teams often include a child psychologist, developmental pediatrician, social worker, speech therapist and occupational therapist.

The team then works with referred children to establish a diagnosis and create a treatment plan. The treatment plan is structured to use local resources if possible, said Miller.

Although the clinics work to provide a diagnosis and treatment plan, Johnson says the reason is simple: "When people leave our clinic, we want to leave them better."

That's why the clinic expanded to Fort Leavenworth in 2009 and recently expanded to Fort Riley this past June.

"Families are being taken care of"

"The goal of our outreach clinics is to reach underserved populations. The families at these military installations each have a unique set of needs, compared to the general population," said Catherine Smith, Ph.D., a pediatric psychologist at KU Medical Center who has been a member of the diagnostic outreach team for five years. "We are expediting the diagnostic processes for these military families and immediately connecting them with the EFMP. As a result, they are able to access the recommended services in a timely manner, both locally and at their future locations."

EFMP is designed to ensure that service members like Lt. Col. Carlton are not stationed at posts where military resources cannot meet the health needs of their family members. But a diagnosis is required to enroll a family member in the EFMP.

"We make sure they are able to focus on the mission because they know their families are being taken care of back home," Burford says of the EFMP.

Burford says the EFMP is also responsible for coordinating assignments and ensuring a "warm handoff to the gaining installation."

That will be very important for Lt. Col. Carlton's family. The Carltons have been at Fort Leavenworth for nearly four years, one of the post's rare lengthy stays, but Mary is preparing for their next assignment, which she expects by the end of the year.

"I won't be sure where we're going until our moving truck pulls away," she says, but she can be sure that their next post will have the resources they need for Sawyer, now a first grader in a mainstream classroom, and Josie, who is now in junior high school on post. "We're really lucky."